Fadiga na Neuromielite Óptica, correlação com depressão e impacto na qualidade de vida / Fatigue in Optic Neuromyelitis, correlation with depression and impact on quality of life

Objetivos: Avaliar a frequência de percepção de fadiga física por escala subjetiva em pacientes com Neuromielite óptica (NMO); correlacionar fadiga física subjetiva com depressão, qualidade de vida, sono e avaliação neurológica; e identificar possíveis associações da fadiga física com características demográficas, físicas e clínicas. Métodos: Foi realizado um estudo transversal descritivo e analítico. Pacientes consecutivos atendidos em 2018 no HFL preenchendo os critérios da NMO (2006) foram selecionados para o estudo. Eles foram entrevistados e responderam aos questionários: Escala de Impacto de Fadiga Modificada (MFIS), Inventário de Depressão BECK, Escala de Qualidade de Vida (SF-36) e Escala de Epworth. Os mesmos questionários foram aplicados em um grupo controle saudável. Os dados demográficos e clínicos foram extraídos dos prontuários. As análises foram realizadas no software Stata® e considerou-se a significância de α<0,05. Resultados: A amostra foi composta por 27 pacientes NMO com idade média de 44,7 anos na entrevista. Neurite óptica bilateral grave ocorreu em 29,6% no início, recorrência em 92,6% dos casos e incapacidade moderada a longo prazo na maioria. As características sociodemográficas da NMO não diferiram do grupo controle formado por 24 participantes. Fadiga total, fadiga severa, escore BECK total e níveis de depressão apresentaram associação estatisticamente significativa (p<0,05) com a ocorrência de NMO. A sonolência diurna na escala de Epworth não mostrou diferença entre os grupos. Todos os domínios de qualidade de vida apresentaram associação estatisticamente significativa (p<0,05) na ocorrência de NMO. Ocorreu uma associação positiva entre fadiga e depressão. As correlações da EDSS com variáveis demográficas e clínicas identificaram uma correlação positiva entre incapacidade e fadiga social e uma correlação negativa com os seguintes domínios do SF-36: capacidade funcional, estado geral e aspecto emocional. Conclusão: Fadiga e depressão foram associadas à NMO. Todos os domínios da Qualidade de vida foram reduzidos em pacientes NMO.

The Visual Evoked Potential in Idiopathic Inflammatory Demyelinating Diseases

Within the group of inflammatory idiopathic demyelinating diseases, there is a great number of diseases that have an initial attack in common, including visual. Multiple sclerosis (MS) is a chronic, demyelinating, immune‐mediated disease, with considerably varying prevalence and incidence. Neuromyelitis optica (NMO), which until recently was considered a variant of MS, is currently considered an independent entity. However, it resembles MS, because it is an immune‐mediated disease characterized by the simultaneous or sequential involvement in time of optic neuritis and extensive demyelinating myelitis. Fifty percent of patients with MS have isolated optic neuritis. However, the frequency of abnormalities ranges from 57 to 100% in visual evoked potential (VEP). Several studies have evaluated the clinical, evolutive, and demographic characteristics of idiopathic optic neuritis and demonstrated their differences among the cases related to MS and NMO. The most common changes in VEP studies in multiple sclerosis are as follows: increased interocular differential latency of P100 wave and the absolute increase in latency of P100 wave. New studies indicate that VEP pattern in NOM spectrum syndromes is different from that of MS

The presence of Uhthoff’s phenomenon and fatigue in the spinal optical form of multiple sclerosis / A presença do fenómeno de Uhthoff e a fadiga na forma óptica espinhal da esclerose múltipla

Objective: To describe the frequency and characteristics of Uhthoff’s phenomenon and its association to fatigue in spinal optical MS patients, and to evaluate quality of life and depression. Methods: MFIS-BR scale, Beck’s depression inventory, quality of life SF-36 scale and a questionnaire based of FDS elaborated by the authors on the influence of heat on fatigue, visual dysfunction and other neurological manifestations were applied. Results: The final sample consisted of 32 patients and 29 healthy individuals. Uhthoff’s phenomenon was found in 31.25% and fatigue on 30% of patients, with significant difference between the groups (6.9%; p=0.018). Strong positive correlation was found between fatigue and depression, and vitality of quality of life domain obtained a higher negative correlation to fatigue. There was no association between fatigue and Uhthoff’s phenomenon. Conclusion: Uhthoff’s phenomenon is present in 1/3 of spinal optical MS patients and is associated to the number of visual events (optical neuritis). Heat mainly worsens fatigue and induces temporary visual dysfunctions in MS. Fatigue is associated to depression and negative impact in quality of life.

Prevalence of epilepsy in a case series of multiple sclerosis patients Prevalência de epilepsia numa coorte de pacientes com esclerose múltipla

OBJECTIVE: The prevalence of epilepsy in multiple sclerosis (MS) patients has been a subject of interest for some years. The objectives of this study were to describe the clinical, radiological and electroencephalographic characteristics of epileptic seizures and to calculate the prevalence of epilepsy in a case series of MS patients. METHOD: Medical charts of MS patients were reviewed and patients who had suffered epileptic seizures were identified. RESULTS: Of 160 cases analyzed, 5 had suffered epileptic seizures and one had comorbid mesial hippocampal sclerosis, confirmed by magnetic resonance imaging in a patient with complex partial seizures that began fifteen years prior to her diagnosis of MS. In the other four patients, seizures occurred both during the acute phase of the disease and in the chronic phase. CONCLUSION: The prevalence of epileptic seizures in MS patients in this study was 2.5%, similar to that found in other studies.OBJETIVO: A prevalência da epilepsia em pacientes com esclerose múltipla (EM) tem sido objeto de interesse há vários anos. Os objetivos deste estudo foram descrever as características clínicas, radiológicas e eletroencefalográficas das crises epilépticas e estimar a prevalência de epilepsia na EM numa série de casos. MÉTODO: Foram revisados prontuários de pacientes com EM e identificados os casos que apresentaram crise epiléptica. RESULTADOS: Dos 160 casos analisados, cinco apresentaram crise epiléptica, sendo que, um caso, houve a presença de comorbidade com esclerose mesial do hipocampo, comprovada através de ressonância magnética numa paciente com crises parciais complexas iniciadas quinze anos antes do diagnóstico de EM. Nos outros quatro pacientes, as crises ocorreram tanto na fase aguda da doença, como na fase crônica. CONCLUSÃO: A prevalência de crises epiléticas nos pacientes com EM neste estudo foi de 2,5%, semelhante à encontrada em outros estudos

Personality factors in recently diagnosed multiple sclerosis patients: a preliminary investigation with the NEO-FFI scale

This article describes some prevalent personality dimensions of recently diagnosed multiple sclerosis patients. A sample of 33 female recently diagnosed with relapsing-remitting multiple sclerosis (RRMS) was assessed with the NEO-FFI personality scale. Beck depression (BDI) and anxiety (BAI) scales were also used. No significant levels of anxiety or depression were identified in this group. As for personality factors, conscientiousness was the most common factor found, whereas openness to experience was the least observed. Literature on the relationship between personality and MS is scarce and there are no Brazilian studies on this subject. Some personality traits might complicate or facilitate the experience of living with a chronic, disabling and uncertain neurological condition such as MS